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Request for General Timekeeper Role

Requestor Name:

Requestor Phone #:

Requestor Email Address:

Timekeeper's Name:

Timekeeper's Emplid:

Timekeeper's Supervisor:

Timekeeper's Supervisor's Emplid:

Type of Assignment:

Permanent

Temporary Assignment

Terminate Assignment

For Temporary Assignments, please indicate Effective Dates:

From Date:

To Date:

For Assignments that are to be Terminated, please indicate Effective Date